Pregnant women, particularly in situations of poverty, may struggle to get information and support to help them through pregnancy, lactation, and early childcare. The struggle may be compounded by the need to continue their livelihoods through pregnancy. Facilitating focused action for pregnant women - knowledge of health, nutrition and entitlements, and medical and counselling services sets the stage for the women to get the adequate rest and nourishment required for the health of the mother and child and have safe deliveries. The easy availability of information availability of good leave without affecting their earnings gives them peace of mind. Such focused action also builds trust in women in the systems that design and deploy entitlements and the community organisations that facilitate access. The effects of safe motherhood live on for the future.
Vulnerable populations often find themselves at the intersection of several deprived categories: whether due to their choice of livelihood, their socioeconomic status, their immediate living situations, or even their pre-eminent health status. One of Swasti’s critical impact areas has been garment factories, where workers are susceptible to health risks, livelihood uncertainties, and workplace discrimination. These issues become more pronounced for migrants and women, a significant proportion of the garment industry workforce. Swasti has had a role in influencing policies and implementing interventions focused on garment workers’ holistic well-being and development, directly reaching over 230,000 workers (the majority of whom are women) across 334+ factories in India.
In March 2020, COVID-19 was officially classified as a Global Pandemic and health crisis. The public health emergency it posed had dramatic spillover effects on people’s lives and livelihoods. Manasa, a product quality checker for a garment factory in the Bengaluru industrial cluster, is one of the many garment workers caught in the pandemic wave.
Hailing from the Ramanagara district in Karnataka, she has been employed in the factory since 2017-18. Her husband works in the same factory. Having migrated away from an agriculturist family in her home village, the garment factory became Manasa’s family’s only source of livelihood. Manasa and her husband were to welcome their first baby in January 2022; their tiny single-room house is stacked with essential utilities, a television, and two large almirahs, but not much for their eagerly awaited newborn.
When the Karnataka State government declared a lockdown in July 2020 with the raging second wave of the dangerous Delta variant of COVID-19, the factory, Manasa’s singular pillar of livelihood support, was shut for two months. It was challenging for Manasa and her husband to get decent jobs during this period. The only resort was to return to their native village in Ramanagara. Her family and extended family lived under one roof, subsisting on essential groceries provided through the household ration card and vegetables grown on their farm.
This lockdown was a delicate phase for Manasa, as she was in her first trimester of pregnancy, and the COVID-19 pandemic was in full force. Manasa acknowledges, “the travel from Bengaluru to my native place was as risky as undergoing a full health check-up at the nearby ESI hospital” since Karnataka showed a daily count of more than the usual 2,000 positive COVID-19 cases. Moreover, the risk of Manasa contracting the infection was exponentially higher, considering that pregnancy lowers the immunological defences in the mother’s body. The doctor she consulted advised her against taking the COVID-19 vaccine, citing the risk of fever and COVID-19-like symptoms due to her decreased immunity.
When the COVID-19 situation improved and the lockdown was lifted, Manasa returned to her job, another risk she chose to take. She mentions, “it was important for me to be able to contribute to the household income, so taking leaves for extended periods was not an option for me.” She was concerned about meeting medical costs if someone from her family contracted a severe bout of COVID-19.
It was back at work that Manasa contacted Swasti, associated with the factory for quite some time. Swasti helped the factory management design workplace guidelines for COVID-appropriate behaviour to ensure the safety of the workers. Swasti and its partner’s frontline program facilitators, through its CAC initiative, had disseminated information on the virus, prevention, and mitigation strategies and even organised vaccination camps targeted at vulnerable women communities. When asked about safety guidelines, Manasa was fully aware of them, mentioning training sessions conducted for sanitation and hygiene practices in the workplace.
Manasa also learned some vital information on entitlements for pregnant women through Swasti and their partner’s healthcare facilitators. She had limited awareness of the Employers’ State Insurance Corporation (ESIC) scheme’s employee health benefits, knowing that it included six months of fully paid maternity leave, but being unsure about the prerequisites or phase of pregnancy during which the scheme could be availed. She was not aware of other livelihood security benefits under the plan. Her lack of complete information prevented her from taking leave during most of her pregnancy. Thanks to the direct counselling by the health facilitators, she was happy to avail these benefits postpartum. “The factory has a maternity leave policy that I now know, allowing me to take sufficient leaves during my pregnancy. I also appreciate that they (the factory) did not push or pressure me to do the strenuous work expected in my job line.”
Manasa had saved up some money for medical expenses, and the company also provided some financial assistance for pregnancy. Manasa shares how in-person counselling and free blood tests made her aware of the importance of healthy blood haemoglobin levels, especially during the initial stages of pregnancy. “In the tests, I found out that I was anaemic. The health facilitator helped me plan my diet and nutritional requirements during pregnancy and lactation. She explained the vegetables and iron supplements I need to build my immune system. Because of this counselling, I followed the diet regularly and improved my haemoglobin levels from 6.5 to 12.8”.
This experience has built her trust in Swasti’s healthcare facilitators and nurses. Manasa also received reliable guidance about the COVID-19 situation in the city, affordable healthcare facilities, and the risk of the infection itself. Her regular information source, WhatsApp, proved unreliable and confusing. Manasa appreciates the healthcare facilitators' very approachable and prompt response: “I can immediately call up the nurse to get instant information on many health issues such as fever and weakness I might be facing. In COVID times, where we are always facing the risk of contracting the virus from amongst the factory workers, the Swasti staff's approachability has helped me stay safe and be aware of COVID-like symptoms, as it may affect my child’s health too.”
Manasa’s story shows the vast difference entitlements and services can make to a pregnant woman’s well-being. Closing the entitlement loops necessitates that eligible people know about the availability of schemes and services and are also supported in accessing these.